Dissertation submitted in partial compliance with the requirements for the
Master’s Degree in Technology: Chiropractic
Faculty: Health Sciences,
Durban University of Technology, 2009

en

dc.description.abstract

Aim
To determine the profile of traumatic cervical spine fractures with respect to the
epidemiology, clinical presentation, types of fractures, conservative and surgical
intervention, short-term post-intervention (i.e. post-conservative and post-surgical)
complications and short-term post-surgical rehabilitation of patients presenting at the
Spinal Unit of King George V Hospital over a 12-week period.
Methods
Patients who presented to the King George V Hospital Spinal Unit from surrounding
hospitals with traumatic cervical spine fractures were evaluated by the medical staff.
Data concerning the epidemiology, clinical presentation, types of fractures, conservative
and surgical intervention, short-term post-intervention (i.e. post-conservative and postsurgical)
complications and short-term post-surgical rehabilitation data were recorded by
the researcher. A p-value of <0.05 was considered as statistically significant. Appropriate
statistical tests were applied to the hypothesis-testing objectives. These involved the
Pearson’s Chi Square Tests for categorical variables or Fisher’s Exact Tests as
appropriate where sample sizes were small. Paired t-tests were done to compare preand-
post-surgical Frankel grading and Norton Pressure Sore Assessment scores.
Results
The number of patients who presented to the Spinal Unit over a 12-week period was 20,
of this number 17 were males, three were females and all were black. Eleven patients
were treated surgically while nine patients were treated conservatively. The most
frequent aetiology of cervical spine fractures was motor vehicle accidents (n = 10)
followed by falls (n = 9). The most common co-existing medical conditions were smoking
(n = 7), HIV (n = 5), alcohol abuse (n = 3) and obesity (n = 3). The most frequent
locations of cervical spine fractures were C2 (n = 6), C1 (n = 4) and the posterior column
of C6 (n = 3), while dislocations occurred primarily at the C5-C6 levels (n = 5) of the
lower cervical spine. Odontoid fractures (n = 6), Jefferson’s fractures (n = 4) and
unilateral facet dislocations (n = 6) were the most common fractures and dislocations
v
observed. Head injuries (n = 4) and lower limb fractures (n = 3) were the most common
extra-spinal fractures. All subjects who sustained head injuries also had associated C1
or C2 fractures. Neurological complications most frequently involved the upper limb
where loss of motor function (n = 8) and weakness (n = 4) were observed. The majority
of the patients (n = 8) reported a Frankel Grading of E. There were no significant
associations between types of fracture and gender with the exception of
fracture/dislocation observed in two females. There was a statistically significant
difference in the NPSA score (p = 0.004). Conservative care utilized included soft collar
(n = 6), cones calipers (n = 6), physiotherapy (n = 4), Minerva jacket (n = 4) and SOMI
(sterno-occipital mandibular immobilization) brace (n = 1) while surgical intervention
included anterior decompression (n = 8), anterior fusion (n = 8), allograft strut (n = 8),
discectomy (n = 8), anterior cervical plating (n = 8), anterior screw fixation (n = 2), a
transoral approach (n = 1) and a corpectomy (n = 1). The short-term post-conservative
care complications observed in this study were an occipital pressure sore (n = 1), severe
discomfort (n = 1) as well as severe neck pain (n = 1), while the short-term post-surgical
complications were severe neck pain (n = 2), oral thrush (n = 1), pneumonia (n = 1),
odynophagia (n = 1) and hoarseness (n = 1). Of the 11 patients who underwent cervical
spine surgery, ten were sent for physiotherapy and one for occupational therapy. No
significant associations were seen between the type of cervical spine fracture and the
age of the subject. There was a significant association between fracture/dislocation and
the female gender (p = 0.016). There was significant negative association between
odontoid fracture and: anterior decompression, anterior fusion, allograft strut, discectomy
and anterior cervical plating (p = 0.006).
Conclusion
The results of this study reflect the presentation and management of cervical spine
fractures at a referral spinal unit of a public hospital in KwaZulu Natal. The impact of HIV
and other co-existing medical conditions were not determined due to the small sample
size in this study. Further epidemiological studies are required to be conducted in the
Spinal Units of all South African public hospitals in order to confirm or refute the
observation of this study.